40561PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
a �
Date f �'3 -‘ Job Address // t- 2 — — l s-A—va Tax Folio
Legal Description flistorically Designated: Yes No
Owner/Lessee / Tenant ,3 , 0-7 (O. tf N'v Win. S I 7y Master Permit #
Owner's Address l l 3 " N� '�— •�✓Z
Contracting Co. /1 L cim f1 cede/ ce
Qualifier J c.Se e e 6a a 44.../9
State # C11- C ® o / 5 ' 6 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION .TN 3 1 �4- L- 1, 9 re.. e-
Square Ft Estimated Cost (value) / D, Q
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
1.k .±,S: PERMIT
C.C.F.
Phone
Address / y i d eJ t J 1 0 2 1+%.47, 11,1a, 33 0
SS# / / Phone '$ C E Q
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
re 552-
Si "• ture of Contractor or Owner - Builder
Electrical
Notary as to Contractor or Owner-Builder
My Commission E fires:
'
O� p.t P�� OFFICIAL NOTARY SEAL
SCOTr W DAVIS
°5J+ * COMMISSION NUMBER
CC255237
71 � q � MY COMMISSION EXP.
OF `' .s:i s 26.1997
f47461
6
Date
Date
NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Buildin
Mechanical Plumbing Engineering